Provider Demographics
NPI:1063470771
Name:KECK, MICHELLE DANNETTE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:DANNETTE
Last Name:KECK
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:12440 ELLINGWOOD PEAK PL
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-4439
Mailing Address - Country:US
Mailing Address - Phone:719-526-7616
Mailing Address - Fax:719-524-4075
Practice Address - Street 1:12440 ELLINGWOOD PEAK PL
Practice Address - Street 2:
Practice Address - City:PEYTON
Practice Address - State:CO
Practice Address - Zip Code:80831-4439
Practice Address - Country:US
Practice Address - Phone:760-267-4115
Practice Address - Fax:719-524-4075
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO0118827163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management